FERGUSON ASSOCIATES EMPLOYMENT APPLICATION

Ferguson Associates LLC fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans with Disabilities Act and applicable federal, state and/or local laws, it is our policy to provide reasonable accommodation upon request during the application process to applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal, state and/or local employment laws and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, The Company maintains a smoke- free workplace. Please answer all questions completely.

Position applied for:

Do you have any experience working in any of the following: Warehouse/Shipping/Receiving/Order Processing?

PERSONAL INFORMATION

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Type of Employment Desired

Full-time

Part-time

Seasonal

Are you available to work 40 hours a week Monday through Friday?

Yes

Are you willing to work overtime or on weekends, if requested?

Yes

Are you 18 years or older?

If under 18 years of age, applicant will be required to present birth certificate or work certificate as required by State and Federal Law.

Yes

What is minimum hourly rate or annual salary that you will accept for this position?

Have you ever applied to or worked at Ferguson Associates before?

Yes

As a part of the hiring process, we ask all candidates to undergo background check. Are you willing to undergo that check?

Yes

Are you legally authorized to work in the United States?

Yes

Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)?

Yes

Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

EDUCATION

Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:

High School or GED

Yes

College/University

None

Associate Degree

Bachelor's Degree

Master's Degree

Doctoral Degree

Some college; No Degree

Other/Certifications

EMPLOYMENT HISTORY

Please complete for all full-time or part-time employment beginning with most recent employer. You may include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include military assignments and voluntary employment. (A separate sheet may be attached.) You must explain any gaps in your employment history.

Company Name and Address (1)

Supervisor

Please provide name, email, and phone number

May we contact?

Yes

Start date of employment

YYYY

End date of employment

YYYY

Job titles and describe job duties:

Reason for leaving:

Company Name and Address (2)

Supervisor

Please provide name, email, and phone number

May we contact?

Yes

Start date of employment

YYYY

End date of employment

YYYY

Job titles and describe job duties:

Reason for leaving:

Company Name and Address (3)

Supervisor

Please provide name, email, and phone number

May we contact?

Yes

Start date of employment

YYYY

End date of employment

YYYY

Job titles and describe job duties:

Reason for leaving:

PROFESSIONAL REFERENCES

Please list three individuals unrelated to you with whom you have worked who know your qualifications for this position.

Reference 1

Please include name, company, phone, email, and relationship.

Reference 2

Please include name, company, phone, email, and relationship.

MILITARY

Complete only if you served in the military.

Number of Years /Months of Service:

Date of Discharge

YYYY

Describe any military skills, training or experience you believe are relevant to the job you applied for:

APPLICANT’S ACKNOWLEDGMENT

I certify that the answers given herein and during the entire application process (including but not limited to information provided in resumes, attachments to this application, interviews or otherwise (if applicable)) are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers during the application process may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts during the application process may be cause for my dismissal at any time without prior notice. I consent to and authorize the Company to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give the Company (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference. I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR THE COMPANY WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE COMPANY. I ALSO UNDERSTAND THAT MY AT-WILL EMPLOYMENT STATUS WITH THE COMPANY MAY ONLY BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING SIGNED BY THE OWNER, PRESIDENT OR CEO OF THE COMPANY.

Signature

Please type name below for signature

Date

YYYY

Hello! We always look forward to going through applications of great people who’d like to work with us at Ferguson Associates. Thank you for applying for a position with us, and here’s a confirmation that we received your application. One of our recruiters will contact you shortly to let you know about the status of your application.